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0203-413 (RPL)U 1= N t) W O'er 'M Q U� w r Di Z �0., i� I.—CD :JUI- F-aa- N Z co LO N ON U °) C Q Z ra0 0 J J ED U U O _Z ao 5 r` 0 J I� LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date &arS1;�s� 0153 MI C.O-S 10131/2{ Date'• �'�. i `)- Signature of Contractor f " + �'� . OWNER -BUILDER DECLARATION u I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044,, Business & Professionals Code). () I am exempt under Section , B&P.C'for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ( ) I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ( ) I have and will maintain workers' compensation insurance, as required by Sl16n 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier 2STATE COM I'M SAT I Policy No. 0460006168-01 (This section need not be completed if the permit valuation is for $100.00 or less). ( )' I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant llJ, 1" 4 4� Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $•100,0.0.0 -in._ . addition to the cost of compensation, damages as provided for in Sec on 3706�4,a of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Buildin�' Safety for a permit subject to the conditions and restrictions set `f"o h onh9sR application. 1. Each person upon whose behalf this application is made & e h p �`M whose request and for whose benefit work is performed under o pursuam any permit issued as a result of this applicaton agrees:to, & shall•; indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct.sI agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter,upon the above-mentioned property for inspection purposes Signature (Owner/Agent) �,� - - :,�✓!a��f*� DateT' BUILDING PERMIT PERMIT# . r Ei2(I� X51: DATE VALUATION LOT TRACT 7„�,t3fWE.iit3 29 JOB SITE�� �� ADDRESS �'-1� ri v.".ru, µV�T�'MT1.0.8.1 v s r o L '� APN -- OWNER CONTRACTOR/DESIGNER/ENGINEER �n s�3 rCi'V'l�1iu i ' %P T OC�)vi cvi:is�li t�lf 1. C C'AL.I;E+i71 NIA P OLS � SPA.-, CrOP MAK- C0 200 F. �'v�A:�fi�ilJ'C7Ttw NVF #100 .. , , 74725 ONE DRIVE, SLUE #A ESCOMDO CA 99023 PAL1uI1:1ES1;•F',.T' CA 92260 (760)340-9000 C,W4 i 00.355 USE OF PERMIT POOL A3�1.b:rKX11 SPA POOL ANTS MPA, 13410 "S1 T'IREPIT 446 .P,,E@f Ii ALARMSMAR llILS SHAII 8E DI PLACE PNC?R TO P12.E1PLt13TER. 111SdaECT1014. 11001, 90,1UTPA4,EN T E1,14CLO sLIRE NOT INCLUDED I'N P1-rHM',.°T. 41001, KNDIOR SPA 2 90©.0{t 1,s MIMJL4.Y.tlMD COW QV !i~O.MMUMON .iw �lit+'vNYd ' F�1.6[•S.f7 b�7��'tL � ✓i: 101Fti t4�n����c7 �. i' R��.�af0 Ct 14M'P,UC T1014 FEE 101-000-419-000 ��5d.6Iu IMEC;l•1.Ni INSPECTION RECORD OPERATION DATE I INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS steel POOLS - SPAS Set Backs Electric Bond �� l Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test inal Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping . Gas Test Appliances Final LltilU Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit R:sugh Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) Final COMMENTS: / v Coachella Valley Unified School District 83-733 Avenue 55, Thermal, CA 92274 (760) 398-5909 — Fax (760) 398-1224 This Box For District Use Only DEVELOPER FEES PAID AREA: AMOUNT LEVEL ONE AMOUNT: LEVELTWOAMOUNT: MITIGATION AMOUNT: COMM/IND. AMOUNT: DATE: RECEIPT: CHECK N: INITIALS: CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Name: David & Elizabeth Byrnes Date: 05/29/09 Owner's Name: David & Elizabeth Byrnes Phone No. Project Address: 56-134 Baltustrol, La Quinta, CA 92253 Project Description: Casita Addition to existing Single Family Residence (attached casita) APN: 775-360-019 Tract #: Lot #'s: Type of Development: Residential INN Commercial Industrial Total Square Feet of Building Area: 358 sq. ft. Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under penalty of perjury and further represents that he/she is authorized to sign on behalf of the owner/developer. Dated: 05/29/09 Signature: Le/ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 9 * * * * * * * * * * * * * * * * * * * * * * SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE) Education Code Gov. Code Project Agreement Existing Not Subject to Fee 17620 65995 Approval Prior to 1/1/87 Requirement Note: Pursuant to AB -181 any mobilehome being replaced or Number of Sq.Ft. 358 sq. ft. relocated within the district boundaries is exempt from Amount per Sq -Ft- $ 0.00 developer fees Any additons to an existing residence of 500 Amount Collected $ 0.00 sge_feet or_less is exempt from developer fees.l�-�� Building Permit Application Completed: Yes/No By: Carey M. Carlson, Asst. Supt., Support Services Certificate issued by: Leticia C. Torres, Facilities Analyst Signature: NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STA T OF FEES Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up to three (3) such extensions may be granted. MV:c/mydocs/devfees/certificate of compliance form tablesTO USE.doc 1/16/03 T